Posted
by
Zonk
on Sunday April 29, 2007 @05:35AM
from the need-a-supplement-now dept.

twilight30 wrote us with a link to an article in the Globe and Mail. If further study bears out the findings, new research into the causative agents behind disease and cancer may have a drastic impact on the health of citizens in Canada and the US. According to a four-year clinical trial, there's a direct link between cancer and Vitamin D deficiency. "[The] trial involving 1,200 women, and found those taking the vitamin had about a 60-per-cent reduction in cancer incidence, compared with those who didn't take it, a drop so large — twice the impact on cancer attributed to smoking — it almost looks like a typographical error. And in an era of pricey medical advances, the reduction seems even more remarkable because it was achieved with an over-the-counter supplement costing pennies a day. One of the researchers who made the discovery, professor of medicine Robert Heaney of Creighton University in Nebraska, says vitamin D deficiency is showing up in so many illnesses besides cancer that nearly all disease figures in Canada and the U.S. will need to be re-evaluated. 'We don't really know what the status of chronic disease is in the North American population,' he said, 'until we normalize vitamin D status.'"

The cancers are different and have different risks. As the article says, by limiting exposure to sunlight you're trading skin cancer (which is easily detected, quite easily treated and often not fatal) for the scarier cancers like bowel cancer which are implicated in a lot more deaths.

Now I'm waiting for another research showing that the intake of vitamin D causes some other serious illness...

OK. Skin cancer. The main source of vitamin D in humans is through exposure to sunlight. Increase that without being careful and your risk of skin cancer goes up. Also, vitamin D overdosing from supplements is entirely possible and does have nasty side effects, although it's not possible from natural production due to exposure to sunlight.

There we go, cynicism confirmed, and it wasn't as bad as all that. Now, let's get down to reality: as vitamins, the vitamin D group have been identified as essential for human nutrition. Not useful, essential. As in, we would die without it. There's strong evidence, in fact, that the reason people that moved away from the equator developed paler skin was to maintain high production rates of vitamin D. So, quite frankly, even if the intake of vitamin D killed us, we'd have to have it as if we don't take it we die anyway, therefore the entire point is moot.

You also forgot to add that besides a number of major cancers Vitamin D defficiency also has clear links to obesity as well. Its defficiency in childhood results in soft tissue growth overtaking bone development and very quickly going down the fat kid spiral. Nearly every obese kid aged 7-14 has classic X legs which are a clear indication that he/she has gone through vitamin D defficiency at some point in their life (usually past the age of 2, earlier results in O-shape). For every 1 person the "Dip your child into factor 40 cream" cretins save from skin cancer tens will die of other vitamin D defficiency related illnesses.

Just look at Australia. It was the first to go into the "hide in the shade" overdrive and we constantly get Australian studies quoted about the dangers of sun onto us (without any corrections for the fact that the numbers should be corrected for different lattitudes). It now is the world leader in obesity overtaking the US.

It is proudly followed by surprise surprise - UK which has taken all AU studies and is applying them blindly despite being at way further from the Equator. It is quite funny, every time I get some "scary" number quoted I ask the origin and it ends up being Australia from the height of the Ozone hole period. In the UK there is a further complicating factor - GP incompetence. None of the UK GPs and health visitors carries out the standard checks for rachitis on children. Further to this, if you ask them they tell you not to worry. If a child in the age 3-18 months get an abnormal hair loss, they tell you to go get special shampoo for him instead of running blood tests (which the rest of EU does).

Did you notice the link in the article to the vitamin D council?
Did you notice the doctor who did the study is part of the vitamin D council?
Although they are a non profit, they do provide links to lots of people who will be happy to sell you some vitamin D.

I work for a small biotech company that has been doing cancer research and we never put out a press release every time we think we are on to something interesting or promising. We do study after study not just to establish a link, but to understand exactly how a compound may stop or prevent cancer. I wish people would take more time to ensure they have lots of data to go on before saying they have found a "direct link"

And on another note, I find it hard to believe that so many people are deficient in vitamin D.
We may spend a lot more time indoors than our ancestors, but I feel confident I am getting enough sunlight and enough D in foods i consume.

It's interesting to note that regardless of the type of cancer (save some of the forms of mesothelioma that you tie to chemical exposure) the majority of cancers can be traced back to oxidative stress.
As a physician I've seen remarkable results with dropping the usual chemical approach and using super antioxidents such as Acai extracts and grape-seed extracts.)
My fellow physicians need to get off of the chemical bandwagon and really do some research in this direction.
Cheers,
Nick

The Inuits' darker skin can be explained by the fact that they've historically lived in the snow, which reflects UV light, doubling their intake. I don't know under which definition you're calling Mongols dark skinned, because they certainly don't look it to me [thecia.com.au], nor do the similarly coloured Ainu.

This isn't exactly my field, though - do you have an example of why you'd call them dark skinned?

northern Europe and United States, areas where sunshine is at low levels for as much as nine to ten months out of the year.

Dude, I live in Wisconsin (there is just a weee little sliver of Michigan between WI and Canada) and it's not as light-deprived as you make things sound. Do you think we scurry around in the dark with flashlights like mole-people (except for June and July)?

Interesting sidebar: I was in Philadelphia recently on a work-related trip. On the way to the airport, the Philly cabbie asked me "Where are you from?" I had a feeling that "Milwaukee" probably wouldn't ring any bells with him so I tried "Wisconsin." He asked "Which coast is that on?":^) I thought to myself: "Ummm, just watch the road and get me to the airport so I don't miss my Midwest flight outta here."

The reason I have heard cited for why people such as the Inuit, or Italians have darker skin is because of fish intake.

Coastal peoples, such as the Inuit, have a high intake of fish in their diet, and so get a lot of Vitamin D. Same goes for the Italians.

My guess for the Amazon natives having lighter skin would be that they live in the jungle? Not out in the plains, and so they would still be receiving less sunlight than people living in the Savannah. Just a guess, but it fits with the theory.

So, light skin is still associated with low Vitamin D levels. If there is strong sunlight, or a large amount of fish in the diet, darker skin is advantageous.

It's more than that. Sunlight deprivation is associated with both depression and heart disease, the latter of which is one of the largest killers in all first world countries, and the first of which will certainly shorten your life. People who stay indoors to avoid skin cancer are making a life-damaging error. The impact of sunshine on heart disease is much, much more significant than your chance of getting melanoma.

As an American I can only say this: focusing on Vitamin D (or any other single nutrient) as a factor in causing disease X or condition Y simply shifts our attention from the real problem. And that is the simple, undeniable, thoroughly-established fact that our diet sucks. Sucks on a Biblical scale. If more of us accepted that and made some (admittedly significant) changes to that dietary intake, there'd be one hell of a lot fewer people with cancers of any kind. Not to mention strokes, and heart attacks, and diabetes, and all of the other diet and obesity-related conditions from which we suffer. My mind is absolutely boggled by the sheer scale of health problems resulting from typical American fare, and I feel sorry for people in other countries that are adopting American food because they think it's better for them. Chances are, compared to their traditional diet... it isn't.

For example, my fiancee is North African, and her traditional meals are largely vegetarian with relatively few percent of calories from animal-derived foods. She's never had a health problem. Her grandmother is 103. Granted, the reason the average person from her country doesn't eat more meat is because they can't afford it, not because they have some inhibition about eating meat. Yet, the wealthier members of the population there are eating more and more American-style foods and guess what... they're already seeing an increase in cancers, strokes, heart attacks and diabetes, but without the drugs and surgical techniques we use to try and compensate for the lifetime abuse of our bodies.

Don't get me wrong: I'm glad they're researching the effects of insufficient Vitamin D reserves on cancer. We can just add that into our total body of knowledge about diet and health. But we really need to keep our minds on the big picture, which clearly says that we don't eat right. Too many people I know have suffered or died from what they ate over their shortened lifetimes. So here I am, now at the age where I have to take a good, hard look at my family history, and take stock of my future health. The conclusion I've reached is this: either I make some serious changes to what I eat, and the way I live... or the outlook will not be good. So, I'm making those changes.

My father died of diabetic complications at the age of 62, and his doctor said to me "that's one possible future for you." It was an awful, painful, degenerative death that lasted several years. I don't want to go that way, and sometimes we have to accept that changing a few little things here and there aren't going to cut it. Taking some Vitamin D supplements, or getting some more Sun, or eating some more broccoli... that's fine so far as it goes. It doesn't go far enough for most of us. Not nearly far enough.

Okay, after reading the entire hysterical FA, I want that ten minutes of my life back. A sensationalistic article published on a slow-news Sunday in the Globe and Mail (where I always look for good peer-reviewed scientific evidence) says that a study "will be published" in June that will revolutionize the way that I, a practicing physician, view chronic disease.

Or maybe not. I can't tell whether the study was prospective, controlled, or blinded. I can't tell what cancers were examined. I CAN tell you that four years is ridiculously short for a study examining the emergence of cancer, which appears (we're not sure yet) to take decades in most cases. Since the journal is not named, I don't know its reputation or whether the study was peer-reviewed (and by what peers). In other words, I have no information that allows me to evaluate the claim, except that the claim itself was published in the newspaper. This in itself is not a good sign.

It is a violation of scientific ethics to pre-announce your results in the lay press without also revealing the details of your methods and the limitations of your study. In the case of a "miracle" result for a common supplement, it rises to the level of being truly suspicious. Extraordinary claims really do require extraordinary proof, and making such a claim in a Sunday supplement in the complete absence of accompanying evidence is the stuff of psychics and snake oil.

I am skeptical. I am willing to be convinced, but I'm also willing to entertain cash bets on the probability of this being true and clinically useful.

Yes, there are white people in the caucus mountains, but there's no evidence to believe that white skin developed there, over and above any other place in Europe.

It does, however, explain Herodotus's "the Colchians [Georgians] are manifestly Egyptian." The dark-skinned woolly-haired (translator's pre-Imus words) people he reported would be the relict population which didn't bleach out.

That the Caucasus are perhaps the most linguistically interesting place on the whole Earth also adds a least a little credibility to Blumenbach's wild guess.

The Caucasus were next to the "Ukrainian" glacial maximum refuge, where folks got funneled together as the ice grew, folks whose diets (and thus vitamin D intake) were changing rapidly as the world cooled and all the animals too got funneled together.

Now, I don't think I completely believe all "Caucasians" are descendants of Caucasians. Almost any high latitude low insolation area would do. Perhaps people were dark and eating D-laden fish from Lake Fessenden (boringly called by boring scholars the "West Siberian Glacial Lake") and its Turgay-Aral-Caspian-Euxine-Mediterranean outflow path. Then the glacier dams broke, the Ob Yenisei Lena rivers could drain into the Arctic Ocean, the fish died and people had to bleach out to get vitamin D.

Which would make "white people" the #1 most famous people from Kazakhstan!

Also, I am fascinated by the role the Urals could have played, because that range is also linguistically interesting seeming to be the nucleation site of the Finno-Ugrian languages.

The most intriguing theory regarding the Finno-Ugrians is that they are Dravidian people who moved north and bleached out. AFAIK there is only a handful of experts taking care of this pet theory. I like it because it would make the Finns a branch of the Dravids, that's right folks, they would be Branch Dravidians!

Strangely enough, from my non-expert reading of experts' stuff, it seems that white people did not originate in Europe. That the original populations of Europe were coastal and riverine fish-eaters who could remain dark despite lower insolation. Indeed, the theory of Europeans originating in Europe, the "Paleolithic Continuity Theory," is nowadays relegated to "alternative" status.

(I apologize for any conflations, simplifications, and confusions. This is just a hobby of mine. Readers are advised to do their own research.)

gets processed by the liver, then 'activated' in the kidneys and off it goes and does good things.

Well, you're only about 10 years behind the research with that description, which puts you even with most doctors. The revolution in Vitamin D research came with the discovery that D is "activated" (25OH-D3 turns into 1,25OH-D3) in a variety of different tissues of the body, not just the kidneys.

Which body tissues do we know can "activate" Vitamin D3? Here's some: prostate tissue, colon tissue, breast tissue. Where are some popular places that cancer likes to form? Same list. Hmmm.

no Vitamin D production only starts to cause problems after several months.

You might be right, but I'm betting not. Here, things get interesting.

In general, significant (not the 200IU your doctor will tell you to take) levels of Vitamin D3 pretty much always correlate with "better outcome" when it comes to cancer. Even folks with skin cancer who have higher levels of D3 do better than folks who don't. But, there are a few puzzling instances where studies find a U-shaped curve. In other words, they find some instances where people with medium levels of Vitamin D3 do better than those with low -- but those with high levels of Vitamin D3 do as bad as those with low levels! What explains these contradictions?

There is a simple hypothesis (far from proved, but I'll bet my pill taking regimen on it for now) that explains this: local tissue conversion of 25OH-D3 to 1,25OH-D3 shuts down as soon as serum levels of 25OH-D3 start to decline, and doesn't start up again until serum levels stabilize.

If this hypothesis is true, then allowing your vitamin D3 serum levels to drop during the winter may be as bad for you as just having low levels of vitamin D3 all year round.

The Google query (( HOLICK VITAMIN D )) confirms than Dr. Michael Holick was a pioneering researcher in this field - his name is missing from the globeAndMail write-up. By analogy to more-pigmented-people needing more sunshine, (( Holick Iguana )) explains that if you happen to own any pets which evolved under baking tropical sun, they might be suffering too...

The 'skin colour' and latitude argument has been dismissed already by evolutionary biologists, not least because humans haven't actually been in Northern Europe for long enough for evolution to have played a role in developing the pale skin colour found there.

Evolutionary change can occur very quickly; we've seen this. Deer moved to an island shrank in size over the course of several generations. Insects change their colors to cope with soot. Outright mutations only take one generation, no matter what changes.

So wherever you got your "information", stop going there. They don't know how evolution works. It isn't just gradual change, though it encompasses that too.

The reason that be is this: a fair-skinned person sitting naked in the sun at the equator may make as much as 20,000IU of Vitamin D in 20 minutes. Now go to your grocery store and find a multi-vitamin with Vitamin D in it. It will likely have about 200IU in it. Now try taking 100 of those so you will get the same effect as sitting in the equatorial sun for 20 minutes. Ooops -- you just overdosed on a lot of other substances!

This discovery that the body makes huge amounts of Vitamin D via sunlight is part of what led to the revolution in Vitamin D research.
It's hard to look at that number and not ask: WHY, did we evolve to make such large amounts of Vitamin D?

That's part of why lots of old Vitamin D research is useless and invalid.
Let's see, do women who take 200IU of Vitamin D a day have fewer bone fractures?
Who cares?
That's like adding a teaspoon of gasoline to a car to test whether gasoline
makes cars go further without stopping or not -- you'll discover a teaspoon
makes no statistical difference, so you've "proved" that gasoline has no
effect on how far a car can go without stopping!

I have yet to read the paper[...]I do not agree that Vitamin D deficiency can be responsible for about 60% cancers.Wow. that takes balls to say. Kudos.

Even more ballsy is put out a press release making the astonishing claim that more than half of all cancer deaths in this country (100,000's lives/year?) could be prevented by a little sunlight or a supplement pill, when the actual data is to be presented at some undisclosed time, at some undisclosed location, in some undisclosed form. Science by vapid press release always takes balls, but this is a different magnitude altogether. The more respected clinical journals frown heavily on press reports far in advance of publication, so expect this to be a substantially flawed or underpowered study that will eventually see daylight in the West Canadian Journal of Gerontological Heliology.

A randomized double-blind study can verify (or rather, fail to not verify, if we want to get technical) the existence of a primary effect and rule out placebo effect.

RCTs don't have to be placebo-controlled, and in fact few are these days, as we have some sort of "standard of care" for most diseases under study. "Primary effect" and "placebo effect" are only semantically different in any event. You test for (the lack of) difference between any two interventions; statistically it doesn't matter if the control intervention is placebo or some standard treatment.

Wouldn't you expect darker skin color--at least on faces--in areas with strong reflected light? Living on permanent ice and snow cover is like living on a mirror. I've been sunburned (no, not just windburned) skiing before.

According to the Gilchrest article, 2 to 8 minutes of exposure to direct summer sunlight is all it takes for a light skinned Caucasian to reach a plateau in their manufacture of the precursor to vitamin D. It then takes several hours for this to turn into vitamin D. So hours of whole-body exposure doesn't actually produce more vitamin D than just a few minutes.

I'm not in this field, so someone else should comment on whether sunlight has additional benefits for psoriasis over oral vitamin D. It seems reasonable that very short (and regular) exposure causes only minimal long term damage.

Latitude and DIET are the important factors. Inuit are darker skinned than the light exposer theories predict, but the traditional diet was very high in vitamin D. Europe was very different.

I have trouble believing that humans were in Europe for too short a time for evolution to occur. There are a great number of genes that have been selected for by disease resistance. Epidemic disease has only existed as an evolutionary factor for less than 10 000 years. Also, these mutations are very simple, its very easy to break a pigment gene by random mutation (much easier than a different but still functional immune receptor for disease resistance.) In fact, as long as dark skin was no longer an advantage we would expect to see people gradually become paler. Just like pigmentation dropped out of many cave dwelling creatures.

"chasing high speed animals around for our food"...Humans are herbivores. We can't catch wild animals. We can't kill them with our teeth, we don't have claws, we would become constipated if we ate them.

Meat eating is a totally unnatural CULTURAL artifact, which is only commonplace because strangely enough, the most violent, sadistic tribes ALL ate meat. Killing animals was fun for sick bastards like that, and it was they who killed the nice, kind, non-violent, loving tribes, who offered them the hand of friendship.

You, sir, are my "hero of the day",... and I'd like to think that I speak for all anonymous cowards. [seriously]

It's wonderful to think that there's some wonderful pill that will cure a stalking monster. There may be one... for each of us, but it's very unlikely to be exactly the same one. I have a little background in medicine,... if you want some interesting reading you may wish to check out _Hope or Hype: The Obsession with Medical Advances and the High Cost of False Promises_ by Deyo and Patrick,... here's somethin' stolen from Amazon, stolen from the NEJM review of the book...

[ i have a small vested interest in the book, since i met one of the authors a few decades back, and thought he was a relatively careful thinker,... but wadda i really know ]

-=-=-From the New England Journal of Medicine, April 14, 2005Armed with support from the Robert Wood Johnson Foundation, Deyo and Patrick make a well-documented -- if depressing -- argument that doctors, scientists, and laypersons alike are far too easily seduced by industry hype for merely new (as opposed to truly better) drugs and medical devices. Deyo and Patrick are appropriately tough on the Food and Drug Administration's (FDA's) drug approval process, in part because the agency's mission does not include weighing one drug against another but, rather, merely approving a new drug if it works at all, even if it has no advantages over cheaper drugs already on the market. The authors are even tougher on the FDA's process for approving medical devices, deftly hanging the agency by its own quotes, such as this gem: "New devices are less likely than drugs to have their safety established clinically before they are marketed." And, of course, they note that it is not part of the FDA's mission to regulate surgical procedures. But the basic message from Deyo and Patrick, both professors at the University of Washington, is that we are all too ready to believe that new, expensive, or aggressive care must be better than older, cheaper, or milder treatments. It is a cultural thing, they argue, citing one study that showed that whereas 34 percent of Americans believe that modern medicine can cure almost anything, only 27 percent of Canadians and 11 percent of Germans do. There is little that is new in this book for anyone who has followed the medical journals and the mainstream press over the past decade. But it is an excellent reference for the reader who wants details of the horror stories that have grabbed headlines: the rise and fall of the fenfluramine-phentermine diet pill (sometimes referred to as "fen-phen"); the high failure rate associated with some cardiac pacemakers; the widespread use of bone marrow transplantation for advanced breast cancer before studies finally showed that it was no more effective, and could be more dangerous, than standard chemotherapy; the appalling suppression or delayed publication of "negative" results in studies funded by drug makers. Citing example after example, Deyo and Patrick are at their most successful when they detail the degree to which the pharmaceutical industry, the most profitable industry in the United States, sometimes abuses its enormous power. Happily, just when you are about to move on to something, anything, else, Deyo and Patrick come up with a comparatively upbeat ending, exploring some remedies for America's ills. They like the idea of having insurers pay provisionally for some new treatments so that the insurers could easily stop payment if a treatment proved worthless or dangerous. They like the idea, endorsed last September by a coalition of editors of medical journals, including this one, of a national registry for clinical trials in order to make it harder for the manufacturers of drugs and devices to suppress negative findings. They want to stop drug companies from claiming marketing expenses as tax deductions -- a no-brainer, in my mind. And they want a better post-marketing surveillance system for drugs and devices. None of this will be ea

I don't think you're being dishonest, but Dermatologists would disagree with you.

According to the Gilchrest article I cited, Dermatologists believe that no amount of exposure to summer sun is completely safe, since the UV needed to produce vitamin D is exactly the same range of frequencies that cause DNA damage and skin aging. Also, according to this article, not only is oral vitamin D just as effective as that produced by the body, but in fact all of the large studies that show benefits of higher doses of vitamin D have been conducted using oral vitamin D. To quote from the abstract of the study cited in the original post, "it was achieved with an over-the-counter supplement costing pennies a day".

The Gilchrest article also points out that you can get the full vitamin D benefit from sunlight even if you use a high SPF sunscreen, since you only need the equivalent of a few minutes unprotected exposure. Tans are pretty, but there is a cost that is paid later in life.

Humans are opportunistic scavengers. We are capable of chasing down the weak and ill animals, we have a greater natural stamina than wolves, horses, zebras, bison, deer, oxen, and many other animals. Our teeth have grown smaller because we cook our food, however humans are quite capable of killing many animals with our bare hands. We also have been tool users for millions of years, and our bodies have adapted to this as well. Indeed the most violent and sadistic tribes enjoyed killing animals. And they got significantly better nutrition than those that do not. The nearest related species to humans also is an opportunistic omnivore, though they do eat much more plant matter. Chimps hunt and kill birds, smaller primates, and even members of other chimp troops. They readily eat termites, and even make tools to get them. So, anyone who says that humans are herbivores is woefully lacking in their understanding of comparative biology, and usually blinded to the truth by dogmas of certain religions that believe that harming animals harms the soul. If you look at the way that food is prepared, you'll even notice that humans prefer their meat to be slightly decayed, such as aged beef. Also cooking accelerates non-biotic breakdown of the muscle tissues, making them easier to digest for fat and protein It also kills the very bacteria that we like to partially predigest our food for us. As to the constipation angle, we are omnivores. We do eat vegetable matter as well as animal matter, which cancels this out. And many of the organisms that live in rotting meat (which as I've stated, is what is preferred by humans) can cause dysentery, so it's not as big of a deal as you'd think. Anyway, I'm done with my rant, and I've got karma to burn. Respond or not. I don't really care.

The "correct dose" depends on how much you have now. You really have to get your serum 25OH-D3 measured to know how many IU per day you would need to achieve a target serum level. Worse, unless you totally avoid UVB exposure, you'll need more at some times of year, and less at others.

However, because I know nobody will really follow the advice to see your doctor and get your serum levels measured, most people could probably safely follow Heaney's conjecture [direct-ms.org] that 2,200IU or more might be required to get your serum levels up to... basically the level that researchers are coming to believe is required just to keep your skeleton from falling apart as you age. (Evolution probably did not really intend us to be just about the only animal who gets osteoporosis when we get old.)